Abstract              Background: Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli. It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases. Aims and Objective: To study the incidence, profile and seasonal trend of pneumonia observed among the patients admitted in tertiary care center. Materials and Method: All the cases admitted in the institute during March 2014 to Feb. 2015 were selected. Out of them cases of pneumonia were studied in detail. During the study duration total 6791 patients were admitted in the institute, out of them 243 were suffering from pneumonia. The detail information of each case was obtained from the record and entered in a prestructured proforma, which included age, sex and presenting complaints. Details about general and systemic examination were also recorded. Data records obtained also included variables as month of admission, month of discharge and year of admission. Results: Out of 6791 admission 243 were diagnosed to be suffering from pneumonia. Thus the incidence of pneumonia was 35.78/1000patients. The most common presenting feature was fever, cough, tachycardia and chest pain (95.88%, 97.94%, 88.89% and 69.14% respectively). Majority of the patients suffering from pneumonia were young adults in the age group of 21 to 40 years (53.5%) followed by 41 to 60 years (32.51%) and ≥61years (12.76%). The incidence of pneumonia among male was more as compared to female. While studying the seasonal trend of pneumonia, it was seen that the incidence of pneumonia was more in winter as compared to summer season. Conclusion: The incidence of pneumonia was 35.78/1000patients. The incidence was more in elderly male with peak incidence in winter season.

Key Words: pneumonia, incidence, seasonal variation, clinical profile.

 

INTRODUCTION

Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli.^1,2 It is usually caused by infection with viruses or bacteria and less commonly other microorganisms, certain drugs and other conditions such as autoimmune diseases.^1,3 According to World Health Organization (WHO) global burden of disease study it has been estimated that lower respiratory tract infections (LRTIs), which include CAP, 429.2 million episodes of illness worldwide and accounts for 94.5 million disability adjusted life years (DA LYs). In adults aged over 59 years, it causes 1.6 million deaths annually.⁴ According to a population-based epidemiological study conducted in Europe has shown that CAP has the highest incidence in winter and spring.⁵ The disease occurs more in males with ratio of 1.4: 1. This pattern is also maintained in hospital data (1.85: 1)⁶. In almost all papers, the incidence is shown to be increased with age. In an epidemiological survey of individuals age 15–64 years, an incremental annual incidence rate was observed (1.12–3.16 per 1000 inhabitants). Patients suffering from community acquired pneumonia and requiring hospital treatment are usually elderly persons and persons with underlying chronic obstructive pulmonary disease (COPD), such as chronic bronchitis (not emphysema); and individuals with severe CAP related to underlying cardiopulmonary function, immune status, or pathogen virulence.⁷ Typical presentation of pneumonia include cough, chest pain, fever, and difficulty breathing⁸ and Diagnostic tools include x-rays and culture of the sputum.

 

MATERIALS AND METHOD

The present retrospective study was conducted in the department of medicine of Dr Ulhas Patil Medical College, Jalgaon. For the purpose of study all the cases admitted in the institute during March 2014 to Feb. 2015 were selected. Out of them cases of pneumonia were studied in detail. During the study duration total 6791 patients were admitted in the institute, out of them 243 were suffering from pneumonia. The detail information of each case was obtained from the record and entered in a prestructured proforma, which included age, sex and presenting complaints. Details about general and systemic examination were also recorded. Data records obtained also included variables as month of admission, month of discharge and year of admission. The collected data was entered in Microsoft excel and was analyzed and presented with appropriate tables and graphs.

 

RESULTS

Table 1: Incidence of pneumonia

There were total 6791 admissions in medicine inpatients department in the study duration. It was observed that out of 6791 admission 243 were diagnosed to be suffering from pneumonia. Thus the incidence of pneumonia was 35.78/1000patients.

 

Table 2: Distribution of patients according to clinical features

* Multiple responses observed

It was evident from the table that the most common presenting feature was fever, cough, tachycardia and chest pain (95.88%, 97.94%, 88.89% and 69.14% respectively).

DISCUSSION

The present retrospective study was conducted in the department of medicine of Dr Ulhas Patil Medical College, Jalgaon with objective to study the incidence and clinical profile of patients suffering from pneumonia. There were total 6791 admissions in medicine inpatients department in the study duration. It was observed that out of 6791 admission 243 were diagnosed to be suffering from pneumonia. Thus the incidence of pneumonia was 35.78/1000patients. In a study by Angel Vila-Corcoles⁹ the incidence rate of CAP observed in population was 14 cases per 1000 elderly person-years. As compared to present study J. Almirall et al¹⁰ observed much less incidence (1.62 cases per 1000 inhabitants) in their study. In England incidence of community-acquired pneumonia has been reported, as 5 per 1,000 persons¹¹, whereas in Finland as 9 per1000 inhabitants >14 yrs of age¹³. In a study from Spain by Santos De Unamuno et al¹⁴ reported an incidence rate of 1.8 per 1,000 inhabitants >14 yrs of age. In another study by Almirall J et al reported an incidence rate of 2.6 per 1,000 persons >13 yrs of age was found¹⁴. It was evident from the table that the most common presenting feature was fever, cough, tachycardia and chest pain (95.88%, 97.94%, 88.89% and 69.14% respectively). Similar findings were also observed by Bashir Ahmed Shah et al¹⁵ in their study. They observed that the maximum number of patients presented with fever (95%), cough (99%), tachycardia (92%), pleuritic chest pain (75%) and sputum production(65%), and leucocytosis (43%). Angel Vila-Corcoles⁹ studied the cases of pneumonia and observed that cough was present in 68.1% cases, fever in 69.8%, dyspnoea in 53.9%, expectoration in 58.1%, pleural pain in 47.4% and crepitations in 83.5%. It was seen that majority of the patients suffering from pneumonia were young adults in the age group of 21 to 40 years (53.5%) followed by 41 to 60 years (32.51%) and ≥61years (12.76%). Thus we could state that the incidence of community-acquired pneumonia was higher in elderly. This period of life is characterized by the occurrence of chronic and debilitating conditions, which tend to be more frequent in males and have been found to be a major risk factor for community-acquired pneumonia¹⁶. The incidence of pneumonia among male was more as compared to female. Similar finding were also reported by J. Almirall et al¹⁰ and Bashir Ahmed Shah et al¹⁵. It was also seen that the age wise distribution of cases among the both sex was nearly same. While studying the seasonal trend of pneumonia, it was seen that the incidence of pneumonia was more in winter as compared to summer season. In a study Fransen H et al¹⁷ reported peak number of hospitalizations due to pneumonia was observed in the spring and winter seasons. FOY et al¹⁸ studied the occurrence of pneumonia over a successive 5 year period and observed peaks occurred in the spring and in the winter. Mohammad Zeeshan Raza¹⁹ also observed peak incidence in spring and winter.

 

CONCLUSION

The incidence of pneumonia was 35.78/1000patients. The incidence was more in elderly male with peak incidence in winter season.

 

REFERENCES

1. McLuckie, A., ed. (2009). Respiratory disease and its management. New York: Springer. p. 51. ISBN 978-1-84882-094-4.
2. Leach, Richard E. (2009). Acute and Critical Care Medicine at a Glance (2nd ed.). Wiley-Blackwell. ISBN 1-4051-6139-6.
3. Jeffrey C. Pommerville (2010). Alcamo's Fundamentals of Microbiology (9th ed.). Sudbury MA: Jones and Bartlett. p. 323. ISBN 0-7637-6258-X.
4. Hebert PL, McBean AM, Kane RL. Explaining trends in hospitalizations for pneumonia and influenza in the elderly. Medical care research and review. 2005; 62: 560–82.
5. Almirall J, Bolíbar I, Vidal J, et al. Epidemiology of communityacquired pneumonia in adults: A population-based study. Eur Respir J 2000; 15:757-763.
6. Thomas K. Epidemiology of invasive pneumococcal disease in adults in India. Medicine Update. Chapter 101:597-599.
7. Noreddin AM, Elkhatib WF. Levofloxacin in the treatment of community-acquired pneumonia. Expert Rev Anti Infect Ther. 2010 May. 8(5):505-14.
8. Ashby, Bonnie; Turkington, Carol (2007). The encyclopedia of infectious diseases (3rd ed.). New York: Facts on File. p. 242. ISBN 0-8160-6397-4.
9. Angel Vila-Corcoles, Olga Ochoa-Gondar, Teresa Rodriguez-Blanco, Xavier Raga-Luria, Frederic Gomez-Bertomeu, EPIVAC Study Group. Epidemiology of community-acquired pneumonia in older adults: A population-based study. Respiratory Medicine (2009) 103, 309-316.
10. J. Almirall, I. BolõÂbar, J. Vidal, G. Sauca, P. Coll, B. Niklasson, M. BartolomeÂ, X. BalanzoÂ. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J 2000; 15: 757-763
11. MacFarlane J. Community-acquired pneumonia. Br J Dis Chest 1987; 81: 116-127.
12. Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in Eastern Finland. Am J Epidemiol 1993; 137: 977±988.
13. Santos de Unamuno C, Llorente San MartÂn MA, Carandell JaÈger E, et al. Lugar de atencio Ân, etiologia y tratamiento de las neumonÂas adquiridas en la comunidad de Palma de Mallorca. Med Clin (Barc) 1998; 110: 290-294.
14. Almirall J, Morato I, Riera F, et al. Incidence of community- acquired pneumonia and Chlamydia pneumonia infection: a prospective multicentre study. Eur Respir J 1993; 6: 14-18.
15. Bashir Ahmed Shah, Gurmeet Singh, Muzafar Ahmed Naik, Ghulam Nabi Dhobi. Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients. Lung India. 2010;27(2): 54-57.
16. Almirall J, BolõÂbar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: a population based case-control study. Eur Respir J 1999; 13: 349-355.
17. Fransen H., (1970), Clinical and laboratory studies on the role of viruses, bacteria, Mycoplasma pneumoniae, and Bedsonia in acute respiratory illness, Scandinavian Journal of infectious diseases, 2 (Suppl 1), pp 1–38.
18. Foy HM, Kenny GE, McMahan R (1970). Mycoplasma pneumonia pneumonia in an urban area, Journal of the American medical association, 214, pp 1666–1672.
19. Mohammad Zeeshan Raza, Ayesha Ahmed, Fatima Ahmed, Aiman Ghani, Nadeem Rizvi. Seasonal incidence of community acquired pneumonia and its mortality in Karachi - A multi-centric hospital based study. International Journal of Environmental Sciences. 2012; 3(2):885-95.